• Jurrijn A Koelen, Jan H Houtveen, Allan Abbass, Patrick Luyten, Elisabeth H M Eurelings-Bontekoe, Saskia A M Van Broeckhuysen-Kloth, Martina E F Bühring, and Rinie Geenen.
• Jurrijn A. Koelen, MSc, Altrecht Psychosomatic Medicine, Zeist, The Netherlands, and Department of Psychology, University of Leuven, Leuven, Belgium; Jan H. Houtveen, PhD, Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands; Allan Abbass, MD, PhD, Departments of Psychiatry and Psychology, Dalhousie University, Halifax, Canada; Patrick Luyten, PhD, Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium, and Research Department of Clinical, Educational and Health Psychology, University College London, UK; Elisabeth H. M. Eurelings-Bontekoe, PhD, Department of Clinical and Health Psychology, Leiden University, Leiden; Saskia A. M. Van Broeckhuysen-Kloth, PhD, Martina E. F. Bühring, MD, PhD, Altrecht Psychosomatic Medicine, Zeist; Rinie Geenen, PhD, Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands.
• Br J Psychiatry. 2014 Jan 1; 204 (1): 12-9.

BackgroundPatients with severe somatoform disorder (in secondary and tertiary care) typically experience functional impairment associated with physical symptoms and mental distress. Although psychotherapy is the preferred treatment, its effectiveness remains to be demonstrated.AimsTo examine the effectiveness of psychotherapy for severe somatoform disorder in secondary and tertiary care compared with treatment as usual (TAU) but not waiting-list conditions.MethodMain inclusion criteria were presence of a somatoform disorder according to established diagnostic criteria and receiving psychotherapy for somatoform disorder in secondary and tertiary care. Both randomised and non-randomised trials were included. The evaluated outcome domains were physical symptoms, psychological symptoms (depression, anxiety, anger, general symptoms) and functional impairment (health, life satisfaction, interpersonal problems, maladaptive cognitions and behaviour).ResultsTen randomised and six non-randomised trials were included, comprising 890 patients receiving psychotherapy and 548 patients receiving TAU. Psychotherapy was more effective than TAU for physical symptoms (d = 0.80 v. d = 0.31, P<0.05) and functional impairment (d = 0.45 v. d = 0.15, P<0.01), but not for psychological symptoms (d = 0.75 v. d = 0.51, P = 0.21). These effects were maintained at follow-up.ConclusionsOverall findings suggest that psychotherapy is effective in severe somatoform disorder. Future randomised controlled studies should examine specific interventions and mechanisms of change.

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